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1756 Hickory HillCITY OF EAGAN Lot 14 Blk Improvement Date Amount knnual Year Payment Receipt Date STREET SURF. 1 8.52 1.70 Pai STREET RESTOR, a js 1976 1034.75 •2 Paid GRADING SAN SEW TRUNK 1974 114.72 .fj 1 P&ld 3£. SEWER LATERAL '3 1976 O68 ? 1022.90 3 P31 WATERMAIN # WA7ER LATERAL 1976 WATER AREA 1976 # STORM SEW TRK 1976 3 .?. STORM SEW LAT 1976 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 1 O.OO 130911 ^2- BUILDING PER. 3 37 13024 -7 sAC 25.00 1309 -2-7 PARK 120.00 1309 -7 CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ?.,.. ? - PHON E: 454-8100 . BUILDING PERMIT ? - Receipt To be used for Est. Value 420." Date 16 ,19 5ite Address 1756 H? C:KORY id 11,L OFFICE USE ONLY Lot BIoCk T Sec/Sub. ???? 2FM On Site Sewage Occupancy MWCC System Zoning ParCei No. W ll A l On Site e ctua ) Const ( GrUC-1: WILLIA013 CiryWater (Allowable) oc Name W 29131 :? I?,? K?,1Jl? RD Address PRV Required of Stories - 3 0 City `- ?'?4N Phone 4Sf?"31'?3 Booster Pump Length Depth o Name VALLBY IF;Y,iE31"MSNT$ CO1QS't' S.F. Total , o? Address 3770 80 LI&xxNM031 Footprint S.F. U? City EA?AN Phone 454"5191 APPROVALS FEES ? a Engr./Assess. Permit ?` I86• Un W W Name 10 W ? = Planner Surcharge . Address Council Plan Review 4 W City PhOn@ Bidg. Off. SAC, Ciry I hereby acknowledge that I have read this application and state that the inlormation is correct and agree to comply with all applicable State of Variance _ SAC, MWCC Water Conn. Minnesota Statutes and City of Eagan Ordinances., Water Meter Signature of Permittee Road Unit A Building Permit is issued to: .1i Treatment P1 on the express condition that all work shall be done in accordance with all Parks applicable State of Minnesota Statutes and City of Eagan Ordinances. `i ? "h.l?0 TOTAL Permit No. Permit Holder Dste Telephone it Plumbing H.V.A.C. E lectric Softener Inspaccion Date Insp. Commenta Footings I Footings II Foundation Framing Roofing Rough Plbg. Rough Htg. Isul. ? / Fireplace Final Htg. Final Plbg. Bldg. Final Cert. Occ. Temp. LP Deck Ftg. Deck Final Well Pr. Disp. 3795 Pil Eagan, M Zoning: Owner: Address Site Adc Plum6er: Th4[nocon Fl ?mh?n4 Co Meter No,4-<-???? Connection Charge140.00 yd_._ ? Size;-??? - Account Deposit: L-R"eader No.: Permit Fee: 10.00 pM? C ? 7 1 agrea t?o ply with eha Vilbga of Eagon Surcharge: .50 ?1- , OrdinanEesqo ?L Misc. Charge Total: By ? Date Paid: ; Date of Insp.: lnsp.: -- SEWER SERVICE PERMIT ?;B OF EROIIN y??I "°?2462 . 3795 Pilof Knob Iload : PERMIT NO. 4/9/75 Eagon, MN 35121 DATE: Pttn - No. of Unite: Zoning: w xorizon Homes Woocl ate II owner: AddYess: 756 Flickor Hill Site Address: Plumbin Co. Plumber: Thom son 6425 00 pd _ of Eagae Connection Chaz ll V apa i I agna to eomply with fha Account Deposic: 00 ? pd 10 . Permlt Fee: ? SurcharBe: Misc. Chazges: By: Total: Date of Inap.: Date Paid: , Inep.: E OF EAGAN WATER SERVICE PERMIT ot Knob Road PERMIT NO.: 1702 DATE: 4/9/75 N 55122 PLJD No. af Uni[s: . i. CITY of EAGAN N4 3537 BUILDING PERMIT Owae: 3795 PiloY Knob Road .... tl.il ...................... .... ....... ......... ?? SS3?f? Eagan, Minnesola 55112 Addsase (Preneni) ......................................................../..................... 459-8100 Suilder .............................................................................................. ,/ a.- 7S' . Dals .......7 .. ............................... Addrew ...................................................................................... DESCRIPTiON BSor?ec To Be Used For Froni Dapih Heigh! Eet. Cos! Pexmi! Fsa Aemesks ac?,s? f LOCATION Slreet. Aoad or olhex Deacriplion oi Localion LW Block Addition or Ttac! ,4r '?..?,!<.??2 /'/- -/'7 I //- ii-,1 ..??1-Ig This permit does aot aalhosize the use of streels, :oads, alleys or sidewalka nor daes St give the owner or hL agent the sight to esea2e anp silualion whieh is a nuisanee os which preseaYS a heaard !o the heallh, safalp, ooavenisnca and generel welfare !o anyone in the communifp. THIS PERMIT MUST SE KEPT ON THE PAEMISE WHILE TFIE WOAK IS IN PAOGAESS. This is 1o ceriify. !hal....7:?1 ..... ............. ?...?. ... . . ...........has permiasioa !o erae! e...1.L... ......... .......... .......... _upoa the above desaribed premise su6jecY io Shpi?ovi cns of all applicable Ordinaztces for the Ciip of agan. ..................................._. 9J"^^-'? ..""'"" .............._...&.:...i""""V.,,G?.." '._.. t- ...... pe! .............................................. • - . ...... .. ..................... ........'.'.''.'.' Mayor 4B Bvllding Impeelos 43 CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 27-199, Eagan, MN 55121 N? 15789 O 8(a S.? BUILDING PERMIT PHONE: 454-8100 Receipt u o Tobeusedfor FIRE REPAIR Est.Value $20,000 pate OCTOBER 26 ,19 88 SiteAddress 1756 HICKORY HILL Lot 14 Block 7 Sec/Sub. WOODGATE 2ND Parcel No. a Name GEORGE WILLIAMS I = Address 2981 PILOT KNOB RD ? City EAGAN Phone 454-3163 a Name VALLEY INVESTMENTS CONST I 0 00 Address 3770 SO LEXINGTON ? City EAGAN phone 454-5191 ?- ¢ "w Name FW qg Addre U aw C1tY_ I hereby ecknowledge lhat I have read this applicaM1On and state that Ihe informehon is correc nd agree to comply wdh all apphcable State ol Minnesota Statute and ty ?of ?E?ag"anO?rdi ce^? k Signature of Permit _ _?.ne,/. ??..a A ewldmg Permit is i u to:??-- ontheezpresscondrt thatallworkshallbe %.ne applicable State of Minnesota Statut and Ciry of Ea?g O?rdjna/n/ce?s. Building OHiCial_. ?yiY?/=? OFFICE USE ONLY On Site Sewage _ Occupancy MWCCSystam _ Zomng On Site Well _ (ACtuap Const CiN Water _ (Allowable) PRV Required _ u of Stones Booster Pump _ Length Depth S.F. Total FootDrint S.F. APPROVALS FEES Engr/Assess._ Permit . 186.00 Planner Surcharge LO.Q.O Council Plan Review Bltlg. Off SAC, City Variance _ SAC, MWCC WaterGonn Water Me[er n Road Unit 3NS r TreatmenlPl Parks TOTAL $196.00 h , I 7 CITY OF EA(}AN 3795 Pilot Knob Road ' . " 'ty• ' , r •'„z„ ? ?? Eagan, Minneaota 55122,04, ''•.. v: . ,;:s- • . , 1'EFtMIT NO.: 599 Tk=e City of Eagan he^eby grants to o f Sedgti+ick Heating? •,cria Ave. " Permit ior: ( Owr.er ) IiEAT G ..- ??` 6 ? ?1Z.`iQ,. and 1745 p t r,'u- "0r. i.zon - Ybodgate 1761 Walnut Lane Fee ?'aid: 3/1?/75 dated this day of ? ;? $160.00 13 4.00 s/c Mar. 75 P?Y':71L8: .:?.C. T"tu1C Build_ng Inapector clrFY oF EIA^'?rr 3795 Pi7,ot I:nnb toaa Ea,,Ln, Mi=E?cota 55122 FEE'•ffT NO.: 794 T:,e City of Ea.gan he^eby gr2nts to Geo. Se.dac.ick Iieating & A[C ____ cf 1001 ;Lenia Ave. So., l..ls. 55416 '?_?.._.? a AEATIi1G ?%IJ Pe.mrit for: (Owner) New Horizon FIOnes - Woodsate at 1756 IIickorv-Hill F'si'suant to apolication dated 2/76 ?'?? Fee Paid: _ g24.4Q- dated this 12 day oi February ? 19 76 > .50 s/c UuilC:ir.g Inspectoi P?eckzanical_ Yerrrii,s: Bicl Totai. CITY OF EaGAN 3795 pilot Knob Road Eagan, Minnesota 55122 PERNIIT NO.: 554 The City o£ Eagan hereby grants to ThomPSOn Plumbing Co. of 12801 '•finnetonl:a Plvd., Minneton;ta a PLUbtB2NG Permit for: (Owner) New HArizoA - Woodgate II - 1756, 1753, 1760, 1762, 1764,11ickory Aill and 1755, 1757, 17511 1761, 176L atr, 1,765 Walnut Lane , pursuant to application dated 4/7/I5 Fee Paid: 5220.00 dated this 9th day of rF=il ? 19 Is . 5.50 s/c Building Inspector Mechanical Permita: Bid Totalc SPERD ro Ragan Village Hail aEvvERO FROM DAknta C'nunt3r Ahvtraet ('n SUBJECT-SpeC131 ASS255II12ritS -NO. 9 9 10 FOLO Pfl IE S S A GE DATE Novamhar 24_ 1q-76_ and return receipt DATE 79- -NO. 10 POLU SIGNED ?••SNAP.P-WAT" FORM 00.902 3 PARTS . . 676 ssi • rainreo ix U.S.A. RETAIN WNITE COPY, RETURN PINK GOPY wnsox Joxss comrnxx • 0, 1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN r • ) ? l, SINGLE FAMILY DWELLINGS c " . f_ INCLUDE 2 SETS OF PLANS? 3 CERTIFIC9TES OF SURVEY, 1 SET OF ENERGY CALCULATIONS NOTEs ADDRESSES FOR CORNER LOTS - CONTRACTOH/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CAANGES WILL BE ALLOWED ONCE BIIILDING PERMIT IS IS3UED. MULTIPLE DWELLINGS RENTAL UNITS FOR SALE fJNTTS # OF UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITA BLDG. DEPT.P 1 SET OF ENERGY CALCULATIONS CONAfERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OE SPECIFICATIONS AND 1 SET OF ENERGY CALCIILATIONS -To ?ui<.c? ,e? f7- A-YnrtGEfJ ?"srnlG To Be Used For: 1f Valuation: 4 0 4eyd Date: Site Address Z75(0 77?ICf?(1??1 ??ILL OFFICE USE Lot ? Block i? On site sewage_ - ' MWCC system Pareel/Sub On site well _ /? ??) ? City water _ Owner (?]?F),P?'? W/?/1Y'G?1 S PRV required _ ? r? Booster Pump _ Address /lGfJ% TVVO? ?City/Zip Code F0406-1-i M N 5571- Phone Zfsv- ,63 I APPROVALS Contraetor Address 37 70 J- L=K(.)GTdI'd City/Zip Code -PWG/jPJ 5-5-/.;ti-3 Phone ?J q ' 7 ?q ( Areh./Engr. Address City/Zip Code Phone # -Engr/Assess Planner Council Bldg. OfP. Variance RM"I 6CT 2 6 qg; Occupancy 19-3 Zoning Actual Const Allowable # of stories Length Depth S.F. Total Footprint S.F. FEES ? Permit 186, Sureharge , VO Plan Review SAC, City SAC, MWCC Water Conn Water Meter Road Unit Treatment P1 Parks Copies TOTAL I 6'ov -.i..f?++?.f".i...__,:s-.-- .. -.>.,...-.-. ?i.a_.•.-•__?,:?:,',...<.-.sa?r?.i.t. ..-...x -?..<..?.?r&dt..i:.ro..•-?:aiL?6.Mjfr::`&?a'4i?°5'.Y'+?° S 3 5 3.S' RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EACAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4875 j ? 3 , -7 IS- New Construction Reauiremenls . 3 2gislered sRe surveys showirg sq. il of lot, sq. ft. of house, and all roofed areas (20°k maximum lot coverage allowed) . 2 cropies of plan showing beam 8 windaw s¢es; poured taund desgn, etc.) • 1 sel of Energy Calculalions • 3 wpies ot iree Preservalion Plan if lol platted after 7/7193 . Rim Joist Defail Optiore selection sheet (61dgs wiM 3 a less unifs) DATE 2-A - CJ:I- SITE ADDRESS / TYPE OF APPLICANT STREET ADDRESU 1d1,10 UU.L,liu,Y?afi TELEPHONE # qJ`Q- 3251 LPOCELL PHONE # 11sZle STATE&, ZI P ??3? FAX# PROPERTYOWNER'2,2)V2j46&TELEPHONE#(oS/° tIC7) ---------------°----------------------°------------------°----------------------- COMPLETE THIS SECTION POR KNEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RL"LES 7672 (4submission type) . Residential Ventilation Category 1 Worksheet Su6mitted • New Energy Code Worksheet Su6mrtted • Energy Envelope Calculatians Submitted Piumbing Conhactor: __ Plumbing system includes: Mechanical Coniractor: Mcchanical system includes: Sewer/Water Contractor. _ Air Conditionin; _ Heat Recovery System MULTI-FAMILY BLDG _ Y `-"N FIREPLACE(S) _ 0 _ 1 _ 2 Pee: $90.00 T?u?? Phone# rmn .1U1 1 7 2002 ----------------------°------------------------...--------------°------------°-----•°- - ------------._...-------- I hereby acknowledge that I have read ihis application, state that the information is cou?c?? --?a?ree?rvc,c,r??Nly with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant 61(5:xp ??j°' OETICF. USL ONI.Y _ Water Softener _ Watcr Heater _ No. of Baths RemodeVReoair Reauiremanh . 2 copies of plan • 1 set of Energy Calculahans for heated addNOns . 1 site survey kr ptenor additlons 8 decks . Indlcate if home served by septic system for additions VALUATION qL'?r35. 7 Lf Phone # _ Lawn 5prinkler _ No. oF R.I. Baths Phone # Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _ UpdateC 4102 OFFICE USE ONLY /O/Gl3 - I 13. 75 ? 01 Foundation ? 07 05-plex ? 13 18•plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Owelling O OS 06-plex ? 16 Fireplace ? 27 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or_ N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)• ? 43 Reroof O 46 WindowslDoors ? 34 Replacement 'Demolitian (Entire Bldg only) - Give PCA handaut to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered ' Type of Const Width REQUIRED INSPECTIONS _ Footings(new bldg) _ FinaUC.O. _ Footings(deck) _ Final/No C.O. _ Footings (addition) _ Plumbing Foundation HVAC Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Framing _ Siding Stucco Stone _ Fireplace _ R.I. _ Air Tes[ _ Final _ Windows (new/replacement) _ Insulation _ Retaining Wall Approved By Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply 8 Storage S8W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total Building Inspector 2005 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Constmction Reauiremenis s f d d ll Remodelffteoair Reamrements 2 copies of pian 6ffite Use OnM Eertn(Survey Recd ,' . _Y ??N roo e area a 3 registered sde surveys showing sq fl of lol, sq ft of house, an 1 sel of Energy Calculations for healed adddions #reePres Plan Reed .'_ ._ Y-N (200/. mmimum lot coverage allowed) 2 wpies o( plan showmg 6eam 8 window srzes, poured found design, elc 1 sde survey for addihons & decks l i Fr?e PrESFleqw[ed - Ortsite SeplieSysiem- =Y - N Y-._ N t set o( Energy Calculations c sys em Addrtron -mdicate donsde sept - 3 copies of Tree Preseroa6on Plan if lot platled afler 71i193 Rim Joist Detail Optlons seleclion sheet (bmldings with 3 or Iess units) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDINU Mincieso[a Rules 7672 - Minnesota Rules 7670 Cate2orv 1 - New Ener code worksheet Enefgy Code CategOry . Residential Ventilation Category 1 Worksheet • 91' (d submission type) Submitted Su6mitted . Energy Envelope Calculations Submi@ed Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 257, plan review fee applies. Licensed Plumber Telephone #( Mechanical Contractor Sewer/Water Contractor Telephone # ( Telephone #( I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurE that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of n Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start withot permit; that the work will be in accordance with the approved plan in the case of work w ich requires a review t approval of plans. / 417C::;E JaJ'1e?% bu &/3 Applicant's Printed Name Ap licant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea ) ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea ) ? 04 02-plex ? 10 OB-plex ? 16 Deck ? 23 Porch (screen/gazebo) ? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex P16g_Y or _ N ? 25 Miscellaneous Work Types ? 30 Accessory Bldg ? 31 Ext Alt - Multi ? 33 Ext. Alt - S F ? 36 Multi Misc. ? 31 New ? 35 Int Improvement ? 38 Demolish Interior x 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building' ? 43 Reroof 46 Windows/Doors n 34 Replacement /1 "Demolition (EMire Bld g) - Give PCA handout to applicant Valuation Occupancy MCES System Census Code Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bidgs Length ' Fire Sprinklered Type of Const Width REQUIIiED INSPECTIONS _ Fooungs(new bldg) _ FinaVC.O. _ Footings (deck) _ Fina]/No C.O. _ Footings(addition) _ Plumbing Foundation HVAC Drain Tile Other Ice & Watcr Roof Final _ Pool _ Ftgs _ Air/Gas Tests Final _ _ _ Framing _ Siding _ Stucco _ Stone _ Brick Fireplace R.I. AirTest _ Final _ Windows _ _ _ _ ]nsulauon __ Retaining Wall Approved By: Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total Building Inspector ??? /?iod uc? ,? 3?) E53 2005 RESIDENTIAL MECHANICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please comple[e for. single famity dwe0ings & rownhomes/condos when permits are required for each unit Date D ? Site Address /75Ze tT/4en'4 t01 1A Unit # Property Owner " 4 O-'1-l Telephone # ( IG?'1 ) °?"(o-O ?S3 Contractor au/ StreetAddress -gog SvQ I7- City ???S?" La'A? State A?i_1 v Zip Telephone #(4pS! )? ga???(o Bond #: Expires: The Applicant is _ Owner ? Contractor _ Other Add-on or alteration to existing dwelling unit $ 30.00 ? furnace _Additional ZReplacement - - air exchanger ? Y air conditioner _New „,,?teplacement other State Surcharge $ .50 Total $ G), bv I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. • Applicant's Printed Name ignature 2005 COMMERCIAL MECHANICAL PERMIT APPLICATION City OfEagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for: commercial/industrial buildings mWti-family buildings when separate permits are not required for each dwelling uni[ Date Site Street Address Unit # Tenanf Name (if applicabie) Previous Tenant Name Property Owner Telephone # ( ) Contractor Street Address City State Zip _ Telephone # ( ) Bond #: Expires: The Applicant is Owner Contractor Other Work Type _ New Construction _ Underground Tank _ Install _Remove **see below _ fnterior Improvement _ Install Piping _ Processed _Gas Nature of Work: *`When instal/ing/removing underground tank, call forinspection byFire Marshal and Plumbing Inspector P¢rmlt FeeS: $70.50 Underground tank installa[ioNremoval $50.50 Mhtfmum (includes Sla[e Sumharge) or ContractValue $ x 1% _ $ PermitFee • If pe rmit fee is $1,000 or less, add $.50 => $ State Surcharge If pe rmit fee is over $1,000, add $.50 for every $1,000 ermit fee $ Tatal Fee i hereby apply tor a Commercial Mechanical Permit and acknowledge that the information is complete and accurate; that the work wil] be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Applicant's Printed Name Applicant's Signature Approved By: , Inspector use csuut or BLACK Ink I For Office Use C~ I Permit I City of EanoR I o Permit Fee: lr 3830 Pilot Knob Road Eagan MN 55122 Date Received: j Phone: (651) 675-5675 j Staff: Fax: (651) 675-5694 L ________J 2 13 RESIDENTIAL PLUMBI G PERMIT APPLICATION Date: / Site Address: ' t " z/& ((ye Tenant: Suite Resident/Owner Name: Phone: - Address/ City zip: 5 Name: j License Contractor Address: ~Z City: State: Zip: Phone: f~ Contact: Email: luR~~. M - Type of Work New ZeplacerriA Repair Rebuild Modify Space -Work in R.O.W. - Description of work: -A 1~ /'z; RESIDENTIAL Water Heater Water Softener Lawn Irrigation RPZ / - PVB) Permit Type Add Plumbing Fixtures Septic System L- Main / Lower Level) Water Turnaround New Abandonment RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $189.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in confor with the rdinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is 'ce st wi ut a permit; that the work will be in accorda with the approved plan i the case of work which requires a review and approval of p s. x lz~ x Ap icant's Printed Name Ap ' t' ig , e FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground -Rough-In Air_Test -Gas Test_ -Final PERMIT City of Eagan Permit Type:Building Permit Number:EA113470 Date Issued:09/04/2013 Permit Category:ePermit Site Address: 1756 Hickory Hill Lot:014 Block: 007 Addition: Woodgate 2nd PID:10-84601-07-140 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes . Jesse Haug Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - % Mers Us Bank Na Tste 3300 Sw 34th Ave Ste 101 Ocala FL 34474 7-10 Services Llc 5162 142nd Path W Apple Valley MN 55124 (651) 238-4862 Applicant/Permitee: Signature Issued By: Signature